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How can the NHS provide personalised care to patients?

The objective for the NHS in England to provide high-quality, personalised care for all patients is a vision that requires a transformative approach to healthcare delivery. This shift signifies a move from the primarily finance and target-driven models of healthcare delivery that we have now to ones that are more patient-centred, emphasising the importance of individual patient needs and outcomes as well as the well-being of NHS staff.

In the international context, healthcare systems around the world are grappling with similar challenges: how to deliver care that is both high-quality and cost-effective, while also addressing the needs of an aging population and the rise of chronic diseases. Many countries are looking towards patient-centred care as a solution.

The World Health Organization (WHO) has also advocated for patient-centred care as part of its strategy to strengthen healthcare systems globally. It emphasizes that patient-centred approaches can lead to better health outcomes, more cost-effective services, and higher patient and staff satisfaction.

However, health systems globally faces unique challenges in implementing such care. For the NHS to adopt a patient-centred model successfully, it can draw on the lessons learned from these international experiences, adapting best practices to fit the unique context of the UK healthcare system. The global shift towards patient-centred care is not a fleeting trend but a response to the clear evidence that such approaches work. By adopting and adapting these international best practices, the NHS can continue to be a leader in healthcare delivery, providing care that is not only effective and efficient but also equitable and respectful of patients’ needs and values.

A more holistic approach to health care delivery would involve:

1. Patient-Centred Care: Tailoring treatment plans to the individual needs and preferences of patients, and ensuring that they are active participants in their own care. This would also involve respecting patient autonomy and decision-making.

2. Staff Well-being: Recognizing that the health and well-being of NHS staff are crucial to patient care. This would involve providing support systems, adequate staffing levels, and addressing burnout and job stress.

3. Quality Over Quantity: Instead of focusing just on meeting quotas and targets, the emphasis should be on the quality of care provided. This could mean more time for patient consultations, and follow-ups, and ensuring that treatments and interventions are evidence-based and help improve health outcomes for patients.

4. Integrated Care: Ensuring continuity of care across different services and providers, which require effective communication and collaboration among primary care, hospitals, mental health, community services, and social care.

5. Preventive Care: Shifting the focus of the NHS towards prevention and early intervention, which can improve long-term health outcomes and reduce the need for more intensive and expensive treatments later.

6. Accessibility and Inclusivity: Making healthcare services accessible to all sections of the population, particularly marginalised groups, thereby addressing health inequalities, and ensuring that healthcare is more equitable.

7. Investment in Staff Training: To deliver personalised care, there is a need for continuous professional development and training for NHS staff, equipping them with the skills to adapt to a more holistic and patient-focused approach.

8. Feedback and Improvement: Regularly collecting and acting on feedback from both patients and staff to improve services and care quality.

9. Technology and Innovation: Leveraging technology to improve patient care, such as through telemedicine, while also ensuring that it does not replace the human touch which is essential in providing compassionate care.

10. Mental Health Focus: Recognizing the mental health component as integral to overall health, ensuring that mental health services are as accessible and well-funded as physical health services.

To achieve this vision requires not only structural and policy changes within the NHS but also a cultural shift that values and prioritises the holistic well-being of patients and healthcare workers alike. This transformation can lead to a more sustainable health service that is better equipped to meet the current and future health needs of the population; such as addressing the health needs of older people and those with complex multimorbidity.

The path to a more patient-centred NHS is both a necessary and achievable evolution in healthcare delivery in England. By embracing a model that places the patient at the heart of care, values the well-being of healthcare staff, and integrates innovation with compassionate services, the NHS can not only enhance the health of individuals but also the health of our society.

This shift, grounded in the principles of accessibility, prevention, and personalised treatment, can forge a stronger, more resilient healthcare system that is equipped to meet the diverse and complex needs of the population in the 21st century. The future of the NHS, therefore, lies not only in numbers and targets, but in the quality of care and the health outcomes of its patients and the national population, marking a return to the core values that have long been the foundation of the NHS.

The essential role of daily exercise in enhancing health and well-being

Regular exercise is essential for good health, contributing to benefits that extend across the lifespan. In the United Kingdom, public health guidance emphasizes the importance of physical activity as a modifiable lifestyle factor that can significantly influence overall health and well-being.

Adults are advised to engage in at least 150 minutes of moderate-intensity activity each week, or 75 minutes of vigorous-intensity activity, along with strength exercises on two or more days a week that work all the major muscles.

Cardiovascular health sees marked improvements with regular physical activity. Exercise promotes heart efficiency, allowing it to pump blood more effectively, and reduces the risk of heart disease and stroke, which remain common health problems in the UK. Additionally, regular exercise can also help lower blood pressure and cholesterol levels, contributing to a healthier circulatory system.

Bones also benefit from exercise, particularly weight-bearing activities like walking, running, or resistance training. These activities stimulate bone formation and can help in reducing the risk of osteoporosis, a condition where bones become brittle and fragile. It’s especially crucial as one ages, because the risk of fractures and falls increases with age.

Mental health improvements are another significant benefit of regular exercise. Exercise can improve the symptoms of depression and anxiety through the release of endorphins, often referred to as ‘feel-good’ hormones. Physical activity can also lead to improved sleep patterns, greater energy levels, and enhanced cognitive function, which is increasingly important in the fast-paced modern world.

Incorporating just 30 minutes of exercise into your daily routine can be the catalyst for these health benefits. This could be as simple as a brisk walk, a cycle to work, or a morning swim. Making it a consistent part of your daily life can help establish a routine, making it more likely to stick as a habit. For those with busy schedules, breaking down the activity into shorter, 10-minute sessions can also be effective as well as being more manageable.

England’s National Health Service (NHS) provides resources and programs like ‘Couch to 5K’ to help people become more active. There is a strong emphasis on inclusivity, with guidance catering to all ages, abilities, and backgrounds, recognising that everyone stands to gain from the adoption of a more active lifestyle no matter what their age or individual characteristics.

Overall, the message from healthcare and public health professionals in the UK is clear: regular physical activity is essential for maintaining and improving health. As a professor of Primary Care and Public Health, I understand the importance of disseminating this message and empowering individuals to take control of their health through informed choices about physical activity. By making exercise a regular part of our daily lives, we can enhance our health, mood, and overall quality of life.

The Foundations of Good Health: Fruits, Vegetables, and Fibre

A diet rich in fruits and vegetables, complemented by a variety of high-fibre foods, is one of the foundations of good health. Eating at least five portions of fruits and vegetables daily is not just a number to aim for – it’s essential for a healthier life. Here’s a deeper dive into why these dietary staples are so crucial for your health:

1. The Powerhouse Pair: Fruits and Vegetables

Rich in essential vitamins, minerals, and dietary fibre, yet low in calories, fruits and vegetables are the unsung heroes of a health-conscious diet. Regular consumption of this dynamic duo can significantly diminish the risk of chronic conditions such as heart disease, hypertension, and certain cancers. The presence of vitamin C, along with a symphony of phytonutrients, bolsters the body’s health defences, offering a spectrum of benefits that go beyond basic nutrition.

2. The Fibre Effect: Sustenance and Protection

High-fibre foods act as the body’s natural sweep, promoting a robust digestive system and offering protection against cardiovascular diseases, strokes, type 2 diabetes, and colorectal cancer. The satiating nature of fibre aids in weight management by reducing the propensity to snack on high-calorie foods, thereby fostering a healthy weight profile.

Understanding Portions

A ‘portion‘ might seem abstract, but it translates into tangible items on your plate. For instance:

– A medium-sized apple or banana counts as one portion.

– A half-cup of chopped vegetables or fruit fits the bill.

– One cup of leafy salad greens or a quarter cup of dried fruit also qualifies.

– When it comes to high-fibre foods, think whole grains, beans, lentils, nuts, seeds, and of course, a variety of fruits and vegetables.

Diversity is Essential

Embracing a rainbow of fruits and vegetables ensures a broad spectrum of nutrients, each with its unique role in health and disease prevention. The different hues are indicative of the diverse vitamins, minerals, and antioxidants they contain, each contributing to the complex tapestry of a healthful diet.

Integrating Healthy Habits

Adopting a diet that includes these vital food groups is a significant step toward maintaining a healthy weight and mitigating the risk of chronic diseases. However, it’s most effective when part of a holistic approach to health that includes regular physical activity, avoiding tobacco, and other healthy lifestyle choices. By making these food groups a daily habit, we pave the way for better health.

The UK government must be more proactive about addressing drug shortages

In a letter published in the British Medical Journal, I discuss why the UK government must be more proactive about drug addressing shortages in the NHS.

The lack of drugs such as methylphenidate required for the treatment of attention deficit/hyperactivity disorder (ADHD) is the latest of many medication shortages we have seen in the UK in recent years.1 These shortages are now too frequent and waste the time of NHS staff such as general practitioners and pharmacists who have to spend time counselling patients and sourcing alternative drugs instead of focusing on more relevant work. They are also very stressful for patients who risk going without key drugs with potentially adverse consequences for their health. For people with ADHD, for example, this could mean going without medication that they require to function effectively at work and school and in their personal relationships.

We need a much more proactive approach from the government, which needs to work with drugs manufacturers and wholesalers to ensure that the NHS has adequate supplies of key drugs to prevent such problems occurring in the future. This could include better data on drug supply and demand to identify problems before they occur; improving local manufacturing capacity in the UK for essential drugs needed by the NHS; price incentives for suppliers; and international collaboration to ensure continuity of drug supply. Moreover, immediate support mechanisms should be put in place for primary care teams grappling with the increased workload caused by these shortages. Patients too could benefit from help such as national helplines or online support to allow them to cope better with the consequences of drug shortages.

Until we see active intervention by government, working in partnership with the NHS and industry, patients in the UK will continue to be affected and the time of NHS staff will continue to be wasted because of drug shortages.

Digital Tools for Enhancing Infectious Disease Screening in Migrants

The European Centre for Disease Control (ECDC) has highlighted a stark reality: migrants in Europe are disproportionately affected by undiagnosed infections, including tuberculosis, blood-borne viruses, and parasitic infections. Many migrants also fall into the category of being under-immunised. The call to action is clear — innovative strategies must be developed to deliver integrated multi-disease screening within primary care settings. Despite this call, the United Kingdom’s response remains fragmented. Our recent in-depth qualitative study published in the Journal of Migration and Health delves into the current practices, barriers, and potential solutions to this pressing public health issue.

Primary healthcare professionals from across the UK participated in two phases of this qualitative study through semi-structured telephone interviews. The first phase focused on clinical staff, including general practitioners, nurses, healthcare assistants, and pharmacists. The second phase targeted administrative staff, such as practice managers and receptionists. Through these interviews, a complex picture emerged, revealing a primary care system capable of effective screening but hamstrung by inconsistency and lack of standardized approaches. Many practices lack a systematic screening process, resulting in migrant patients not consistently receiving care based on established NICE/ECDC/UKHSA guidelines.

The barriers to effective infectious disease screening are multifaceted, stemming from patient, staff, and systemic levels. Clinicians and administrative staff pinpointed the stumbling blocks: overly complex care pathways, a lack of financial and expert support, and the need for significant administrative and clinical time investments. Solutions proposed by respondents include appointing infectious disease champions among patients and staff, providing targeted training and specialist support, simplifying care pathways, and introducing financial incentives.

Enter Health Catch-UP!., a collaboratively developed digital clinical decision-making tool designed to support multi-infection screening for migrant patients. The primary care professionals involved in the study responded enthusiastically to this digital innovation. They recognized its potential to systematize data integration and support clinical decision-making, thereby increasing knowledge, reducing missed screening opportunities, and normalizing infectious disease screening for migrants in primary care.

The conclusion is unequivocal: current implementation of infectious disease screening in migrant populations within UK primary care is suboptimal. Yet, there is hope. Digital tools like Health Catch-UP! could revolutionize disease detection and the effective implementation of screening guidance. However, for such digital innovations to succeed, they must be robustly tested and adequately resourced. It’s not just about having the right tools but also ensuring the entire healthcare system is aligned to support their deployment. With the right commitment, we can ensure that migrants receive the care they need and deserve, safeguarding both their individual health as well as public health in the UK.

Staying healthy this winter and making the most of the NHS

With England’s NHS under immense pressure even before the full onset of winter, here are some tips on how you can make the most of the NHS, use health services more appropriately, and obtain the care you and your family need to protect your health and wellbeing.

  1. Attend for appointments for medication reviews and for the management of long-term conditions when invited. This is important because it helps to ensure that your medication is up-to-date and that your condition is being managed effectively.
  2. Take-up the offer of Covid-19 and flu vaccinations if you are eligible. Vaccinations are the best way to protect yourself from these serious illnesses. Also take up any other NHS vaccinations you and your family are eligible for.
  3. Use the NHS app to book appointments, view your GP medical record and order repeat prescriptions. This is a convenient and efficient way to manage your healthcare.
  4. Be aware of the range of options for NHS care – including opticians, pharmacists, self-referral services (e.g., podiatry, Talking Therapies, smoking cessation), and NHS 111. This can help you to access the care you need quickly and easily.
  5. Use the NHS electronic prescription service so that your prescription is sent directly to a pharmacy. This can save you time and hassle.
  6. For queries about hospital care, contact the hospital Patient Advice and Liaison Service (PALS) team rather than your GP. The PALS team is there to help patients and their families with any concerns or questions they have about their hospital care. The contact details are usually present on the hospital’s website.
  7. Apply for online access to your hospital records if this is available. This can give you access to your medical information at any time, which can be helpful if you need to manage your own care or if you need to see a new doctor.
  8. Don’t Smoke. Smoking is a major risk factor for many diseases, including cancer, heart disease, and stroke.
  9. Exercise regularly including outdoors so that you get some sunlight exposure. Exercise is important for overall health and well-being, and sunlight exposure helps to produce vitamin D, which is essential for bone health.
  10. Eat 5 portions of fruit and vegetables every day and eat plenty of high-fibre foods. Eating a healthy diet is important for maintaining a healthy weight and reducing the risk of chronic diseases.
  11. Limit your sugar and salt intake. Consuming too much sugar and salt can increase the risk of obesity, heart disease, and other health problems.
  12. Limit your alcohol intake to a safe level. Consuming too much alcohol can damage the liver and increase the risk of other health problems.
  13. Take time to improve your mental health; including by meeting regularly with friends and family. Mental health is just as important as physical health, and it is important to take steps to protect and improve your mental well-being.
  14. Check your own blood pressure. High blood pressure is a major risk factor for stroke and heart disease, so it is important to monitor your blood pressure regularly.
  15. Take your medication as prescribed. It is important to take the correct dose of your medication at the correct time in order to get the best results.
  16. Stay Hydrated: Drinking enough water is crucial, especially when using heating systems that can dehydrate.
  17. Manage Stress: Stress can have a negative impact on your immune system. Consider incorporating mindfulness or relaxation techniques into your daily routine.
  18. Telemedicine: Use telehealth options when appropriate, to save time and minimise exposure to potential infections.
  19. First Aid Kit: Keep a well-stocked first aid kit and know how to use the basic items. This can be particularly useful for minor injuries and illnesses.
  20. Home Safety: Falls and accidents are common during the winter due to icy conditions. Making your home slip-proof can prevent unnecessary hospital visits.
  21. Keep Emergency Numbers Handy: Important contact numbers should be easily accessible, whether it’s on your fridge or saved in your phone.
  22. Regular Hand Washing: Promote good hand hygiene, especially if interacting with vulnerable populations like the elderly or very young.
  23. Know the Signs of More Serious Conditions: Understanding the early symptoms of conditions like strokes, heart attacks, and other acute illnesses can save precious time in an emergency.
  24. Air Quality: Try to keep up the air quality in your home and at work; for example, through ventilation.
  25. Supplement Vitamin D: Sunlight exposure may be limited, so consider vitamin D supplementation if you are in a group that this is recommended for.
  26. Community Support: If possible, check on neighbours and family members who might be vulnerable during the winter months, whether due to age, health conditions, or social isolation.
  27. Use of Over-the-Counter (OTC) Medication: Understand when to use OTC medications for minor illnesses and when to seek professional advice.
  28. Get a good night’s sleep. Sleep is essential for good health, so it is important to get at least 7-8 hours of sleep each night.
  29. Listen to experts on health issues and not random people on social media. There is a lot of misinformation about health issues circulating on social media, so it is important to get your health information from reliable sources, such as the NHS website or healthcare professionals.

The Frontline Clinical Experience: Navigating Uncertainty and Risk in the Early Days of Covid-19

As the Covid-19 Inquiry progresses, it provides an opportunity for reflection on the many challenges faced by healthcare workers like myself during the early days of the pandemic. At that time, the SARS-CoV-2 virus was a largely unknown entity; clinical guidelines were still under development; and personal protective equipment (PPE) was scarce. For those on the NHS frontline, the experience was marked by a mix of anxiety, urgency, and dedication to the patients we were trained to serve.

Unfamiliar Territory 

In the initial stages, Covid-19 was a “novel” coronavirus, the key word being “novel.” There was a scarcity of data, and the disease was manifesting in ways that were not entirely well understood. As primary care physicians, we were suddenly thrust into the realm of the unknown, treating patients with undifferentiated respiratory illnesses that did not yet have well-defined and evidence-based treatment protocols.

The Personal Risk Factor 

One of the most daunting aspects of those early days was the awareness of personal risk. It became apparent that healthcare workers were at a significantly higher risk of contracting the disease through their exposure to infected individuals. One thing struck me and others very profoundly was the pattern among the first NHS staff who died due to Covid-19. Many of them were like me: male, over 50, and belonging to ethnic minority groups. This resemblance was not just a statistical observation; it was a stark reminder of my own vulnerability and that of many of my colleagues.

Ethical Duty vs. Personal Safety 

Yet, despite these risks, we had patients to treat. Faced with an ethical duty to provide care, healthcare workers had to weigh this against the risks to their own health. It was an emotionally and ethically complex position to be in. While the fear and anxiety were real, they had to be balanced against our professional obligations to our patients and the NHS. It was a test of not just our medical skills but also our commitment to the Hippocratic Oath.

The Importance of Resilience 

The job had to be done, and so we donned our PPE, took the necessary precautions, and went to work. This resilience is a testament to the dedication of healthcare workers globally who stood firm in their commitment despite the many unknowns in early 2020. The role of healthcare providers in those critical moments was instrumental in broadening our understanding of the virus, which subsequently guided future public health responses and medical treatments.

Ongoing Challenges 

The situation has evolved, and thankfully, we now know much more about Covid-19. We now also have vaccines that reduce the risk of serious illness, fossilisation and death. Yet the lessons of those early days continue to resonate. Healthcare providers still face risks, both physical and emotional, particularly as new variants of the SARS-CoV-2 virus emerge. The story is not over, but the experiences of the past provide a foundation upon which we build our ongoing responses.

Conclusions 

As we navigate the ongoing challenges of the pandemic, it’s essential to reflect on where we started and the progress we’ve made since early 2020. The Covid-19 Inquiry serves as a timely reminder of the sacrifices, bravery, and resilience of healthcare workers; not just in England but globally. While the anxiety was palpable, their commitment to patient care never wavered. Those initial, uncertain days were a crucible that tested the mettle of healthcare professionals everywhere, and the dedication demonstrated during those times will be remembered as one of the brighter aspects of this ongoing global Covid-19 pandemic.

Measures of Disease Frequency: Incidence and Prevalence

In this post, I will discuss methods used to measure the frequency of disease: incidence and prevalence. These are essential tools for governments, health care planners, doctors, public health specialists, and epidemiologists in their efforts to protect the health of the public.

Incidence is the rate at which new cases of a disease occur in a population during a specified time period. It is calculated by dividing the number of new cases by the population at risk during that time period.

Incidence Rate =  Number of new cases / Person-time at risk  × N

Where N is a number such as 1,000 or 100,000.

For example, if there were 100,000 myocardial infarctions in England each year, the annual incidence would be 1.75 per 10,000 people (100,000 / 57,000,000 x 10,000).

Prevalence is the proportion of individuals in a population who have a disease or other health outcome of interest at a specified point in time (point prevalence) or during a specified period of time (period prevalence). It is calculated by dividing the number of people with the disease by the total population.

Point Prevalence: The number of cases at a specific point in time.

Point Prevalence = Number of cases at a point in time / Total population at that time x N

For example, if there are 4,000,000 people with diabetes in England, the point prevalence of diabetes is 7.0 per 100 people of 7.0% (4,000,000 / 57,000,000 x 100).

Period Prevalence: The number of cases over a specific period.

Period Prevalence = Number of cases during a time period / Average population during the period x N

What methods are used to provide the data needed to measure incidence and prevalence?

There are a range of methods used to measure incidence and prevalence, depending on the specific disease or health outcome being studied and the available resources. Some common methods include:

Surveillance systems: Surveillance systems are used to collect data on the occurrence of disease or other health events on an ongoing basis. This data can be used to calculate incidence and prevalence rates, as well as to track trends over time.

Cohort studies are observational studies that follow a group of people over time to track the occurrence of disease or other health outcomes. Cohort studies can be used to calculate incidence rates, as well as to identify risk factors for disease.

Cross-sectional studies are observational studies that collect data on a group of people at a single point in time. Cross-sectional studies can be used to calculate prevalence rates, but they cannot be used to calculate incidence rates (unless they are repeated over time: serial cross-sectional studies).

With the greater use of electronic health records by the NHS and other health systems, these are now increasingly used to calculate measure of disease frequency such as incidence and prevalence. But these data do have limitations. For example, some problems may not be well-recorded in electronic health records as they rely on patients presenting to health services; and errors an omissions in the coding of clinical data are also common.

How do we interpret incidence and prevalence?

Incidence and prevalence rates can be influenced by a variety of factors, including the following:

Age: Incidence and prevalence rates often vary by age. For example, some diseases are more common in children, while others are more common in adults.

Sex: Incidence and prevalence rates also vary by sex. For example, some diseases are more common in men, while others are more common in women.

Race and ethnicity: Incidence and prevalence rates can also vary by race and ethnicity. For example, some diseases are more common in certain racial and ethnic groups.

Geography: Incidence and prevalence rates can also vary by geographic location. For example, some diseases are more common in certain countries or regions.

All of these factors must be considered when interpreting incidence and prevalence data. For example, if comparing the incidence of a disease in two different countries, it is important to make sure that the populations being compared are similar in terms of age, sex, race and ethnicity, and other relevant factors.

How are incidence and prevalence used?

Disease surveillance: Incidence and prevalence data can be used to track the occurrence of disease or other health events over time and to identify areas where there may be increased risk.

Research: Incidence and prevalence data can be used to identify risk factors for disease, to develop new diagnostic tests and treatments, and to evaluate the effectiveness of public health interventions.

Healthcare programme planning and evaluation: Incidence and prevalence data can be used to plan and evaluate health services and public health programmes, such as vaccination programmes and screening programmes.

Conclusions: Incidence and prevalence are two important measures of disease frequency. These measures can be used to track health trends over time, to identify risk factors for disease, and to plan and evaluate public health and healthcare interventions. It is important to interpret incidence and prevalence data carefully, considering all of the factors that can influence these rates.

New Awareness Campaign to Help Reduce Hospital Admissions for Urinary Tract Infections

A new campaign from NHS England and the UKHSA aims to raise awareness about the prevalence and risks of urinary tract infections (UTIs), particularly among older people and carers, and to reduce hospital admissions related to UTIs.

The campaign offers advice on preventive measures. It emphasizes the importance of staying hydrated, going to the toilet as soon as the need arises, and maintaining hygiene in the genital area. Resources, including posters, are being made available to healthcare services, charities, royal colleges, and care homes to disseminate this information as widely as possible.

The guidance comes ahead of a potentially busy winter season for the NHS, a time when the health service is usually under increased pressure. As part of a larger effort to manage healthcare resources, the campaign encourages the use of alternative services like NHS 111, community pharmacists, and urgent care walk-in centres for less critical cases. This is in line with the broader NHS plan of expanding out-of-hospital care options, including “hospital at home” services and urgent community response teams.

UTIs are particularly dangerous for older adults. Prompt action and early treatment are stressed as critical for managing UTIs and preventing severe outcomes like sepsis or death.

The campaign is part of a larger effort to prepare for increased demand during the winter months and aims to improve public awareness and self-care measures to reduce the need for hospital admissions.

What issues do NHS clinicians need to consider in using this guidance?

1. It is more difficult to diagnose UTIs in older people. Younger people (who will nearly all be women) will usually present with the “classical” symptoms of  UTI – such as frequency, dysuria, urgency and haematuria. Older people can have these symptoms but they can also present with problems such as confusion, agitation, functional decline or lethargy where there is a large overlap with other conditions; making diagnosis more challenging.

2. Another challenge in older people is that some will have asymptomatic bacteriuria (i.e. bacteria in the urine that are not causing problems). When the bacteria are detected, doctors will often treat the patient with antibiotics when the medication may not be needed.

3. Spotting infections early requires knowledge of the symptoms and signs and how these differ in younger and older people. There is also a need to be aware of the complications of UTIs such as sepsis or pyelonephritis and to treat these early.

4. Doctors and patients need to balance the benefits of early diagnosis treatment with the risks of overtreatment with antibiotics. Not all UTIs need antibiotic treatment and some may resolve without it. Overuse of antibiotics contributes to antibiotic resistance as well as putting patients at risk of side effects.

5. Finally, these kind of single issue campaigns will be of limited value unless there is adequate capacity in the NHS for patients to be assessed promptly. Otherwise, patients will end up waiting a long time for appointments with the risk their condition may worsen while waiting for treatment.

Making Sense of Sensitivity, Specificity and Predictive Value: A Guide for Patients, Clinicians and Policymakers

In this post, I will discuss sensitivity, specificity and positive predictive value in relation to diagnostic and screening tests. Many more people have become aware of these measures during the Covid-19 pandemic with the increased use of lateral flow and PCR tests.

In clinical practice and public health, sensitivity, specificity, and predictive value are important measures of the performance of diagnostic and screening tests. These measures can help clinicians, public health specialists and the public to understand the accuracy of a test and to make informed decisions about its use in patient care.

Sensitivity: The proportion of people with a disease who test positive on a diagnostic or screening test.

Sensitivity = True Positives / (True Positives + False Negatives)

Specificity: The proportion of people without a disease who test negative on a diagnostic or screening test.

Specificity = True Negatives / (True Negatives + False Positives)

Positive predictive value (PPV): The proportion of people who test positive on a diagnostic test who actually have the disease.

Positive Predictive Value = True Positives / (True Positives + False Positives)

Negative predictive value (NPV): The proportion of people who test negative on a diagnostic test who actually do not have the disease.

Negative Predictive Value = True Negatives / (True Negatives + False Negatives)

How do we Interpret sensitivity, specificity, and predictive value?

Sensitivity and specificity are linked measures. A test with high sensitivity is good at identifying people with a disease, but it may also produce false positives in people who do not have the disease. A test with high specificity is good at identifying people who do not have a disease, but it may also produce false negatives in people who do have the disease. In general, as sensitivity increases, specificity decreases; and vice versa.

Positive Predictive Value (PPV) depends on the prevalence of the disease in the population being tested. In a population with a high prevalence of disease, a positive test result is more likely to be a true positive. Conversely, in a population with a low prevalence of disease, a positive test result is more likely to be a false positive.

In clinical and public health practice this means that a test can have a high sensitivity and specificity but if it is being carried out in a population with a low prevalence, most positive tests are false positives; thereby limiting the value of a positive test. This is why a test can vary in its performance in primary care (where prevalence of a condition is often low) and in hospital care (where prevalence will generally be higher).

The Covid-19 pandemic brought global attention to the importance of diagnostic test parameters such as sensitivity, specificity and positive predictive value. Initial Covid-19 tests often prioritised sensitivity to capture as many positive cases as possible. However, as the pandemic progressed, the need for more specific tests became clear to minimise false positives that could distort public health strategies. For example, a false positive test could result in a person isolating or staying off work or school unnecessarily.

A test with a high Negative Predictive Value means that it is good at ruling out disease in people who test negative. This is important for public health interventions, such as contact tracing, where it is important to identify people who are unlikely to be infected with a disease so that they can be excluded from further monitoring and isolation.

The pandemic underscored that no single measure—sensitivity, specificity, or predictive value—could offer a complete picture of a test’s effectiveness.

Example of a diagnostic test: A Covid-19 test has a sensitivity of 90%, meaning that 90% of people with a Covid-19 infection will test positive on the test. The test has a specificity of 98%, meaning that 98% of people without Covid-19 will test negative on the test.

The PPV of the test will vary depending on the prevalence of Covid-19 in the population being tested. For example, if 5% of people in a population have Covid-19, then the PPV of the test will be 70%. This means that 70% of people who test positive on the test will actually have Covid-19.

If the prevalence of Covid-19 is 1%, then the PPV will be 31%. This means that 31% of people who test positive on the test will actually have Covid-19. Hence, at times of low prevalence, many positive Covid-19 tests will be wrong.

You can use a Positive Predictive Value Calculator to see how changing sensitivity, specificity and prevalence alters the result.

Screening tests have also become more important as health systems across the world try to detect conditions such as cancer earlier in their clinical course in an attempt to improve health outcomes survival.

Example of a screening test: A mammogram is a screening test for breast cancer. It has a sensitivity of 85%, meaning that 85% of women with breast cancer will have a positive mammogram. The mammogram has a specificity of 90%, meaning that 90% of women without breast cancer will have a negative mammogram. The PPV of the mammogram will vary depending on the prevalence of breast cancer in the population being screened. For example, if the prevalence of breast cancer in a population is 1%, then the PPV of the mammogram will be 8%. This means that 8% of women who have a positive mammogram will actually have breast cancer. Hence, many women who don’t have breast cancer will need investigation to confirm the result of their screening test.

Conclusion: Sensitivity, specificity, and predictive value are important concepts in the evaluation of diagnostic and screening tests. Clinicians, public health specialists and the public should understand the performance of a test before using it in patient care.

In addition to sensitivity, specificity, and predictive value, there are other factors that clinicians should consider when choosing a diagnostic or screening test, such as the cost of the test, the risks and benefits of the test, and the availability of alternative tests.

No diagnostic or screening test is perfect. All tests have the potential to produce false positives and false negatives. Clinicians, the public and policy-makers should use judgment to interpret the results of any test; and to make decisions about patient care, screening programmes and public health policy.